Kidney Disease and Diabetes

Diabetes, medically known as diabetes mellitus, is a metabolic disorder that prevents glucose from breaking down correctly in the body. The body may not respond to insulin properly or the body may not produce enough insulin to control the blood sugar. When the condition is left untreated or an incorrect or inadequate treatment is prescribed, the continuous or recurring events of high blood sugar can do quite a bit of damage.

The most common problem in people with diabetes is that the sugar levels within the bloodstream begin to cause issues with the cardiovascular system. Oftentimes, high cholesterol goes hand-in-hand with diabetes. When the vessels become damaged, blood may not be able to pump efficiently.

Multiple Organs Affected

In addition to the heart, the vessels in other organs may also be affected. This leads to the entire organ potentially functioning improperly. For instance. the kidneys are comprised of many tiny blood vessels that work hard to filter the waste from the blood. Not only do they filter waste, but they also filter out excess fluid. When diabetes health is not taken care of properly, it can cause damage to the tiny vessels in the kidneys. This means that the waste and toxins will build up in the blood.

Besides the interruption of filtering the blood, the effect of hyperglycemia on the blood vessels and the nerves can lead to numbness and tingling in the extremities. When diabetes health is not managed properly, this nerve damage leads to pain and a burning sensation in the affected area. In the most severe cases, a patient may lose all feeling in the limb. This can lead to an injury, sore or infection arising and the patient being unaware until physical signs occur. With severe cases, amputation of the limb may be necessary.

Destructive to the Kidneys

According to the American Diabetes Association, diabetes is destructive to the process of the kidneys acting as a filter. While the kidneys remove waste and water through the tiny vessels known as nephrons, they leave protein and red blood cells in the blood, since these particles are too large to pass through the filtration system of the kidneys. When diabetes health is not controlled and high blood sugar levels get too excessive, they lead to the kidneys overworking and filtering too much blood. Eventually, beneficial protein slips through the nephrons and is released from the body with the urine.

The extent of the kidney damage from diabetes varies. In the early stages, it may go unnoticed. As it worsens, it may turn into end-stage renal disease or complete kidney failure that requires dialysis or a kidney transplant to correct.

To prevent kidney problems, patients with diabetes should control their condition with diet and exercise. Moreover, the patient should monitor his or her carbohydrate intake. In addition, he or she must take his or her diabetes medication as prescribed. The treatment options may include glyburide, insulin or metformin. The patient may also take Actos. However, while particular diabetes drug may be effective at regulating diabetes health, it may also lead to cardiovascular problems, including heart attack, stroke and congestive heart failure. Individuals with diabetes who take Actos for many years may experience bladder cancer. Due to this, thousands of lawsuits have been filed. The patient should be monitored for liver damage while he or she is taking the medication. ~DrugWatch.com~

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Many Kidney Disease Patients Unaware

Many people diagnosed with chronic kidney disease do not know they have the disease, according to report published in the March issue of the American Journal of Kidney Diseases.


Researchers at Vanderbilt University Medical Center in Nashville, Tennessee, surveyed 401 people with kidney disease attending a nephrology clinic. More than 75 percent of participants had stage 3 chronic kidney disease or above. While 94 percent of patients surveyed were aware they had a kidney “problem,” more than 30 percent were unaware they had a serious, potentially life-threatening disease. All of the patients surveyed were under the care of a kidney specialist, or nephrologist.

“The lack of awareness of chronic kidney disease among those who are affected appears to be greater than other health conditions,” said study co-author Dr. Julie Anne Wright from Vanderbilt’s Division of Nephrology and Hypertension. “Even when patients are under the care of specialists, they frequently have a limited understanding of fundamental topics, including symptoms, the course of kidney disease and risk factors such as diabetes and hypertension. This study highlights the need for providers to ensure that communication is not only delivered but understood between all parties involved.”

Beyond diagnosis awareness, results of the 34-question survey also showed that 78 percent of participants did not know that the disease may progress with no symptoms. More than 34 percent were unaware that they were at increased risk for heart disease and 32 percent did not know that the kidneys make urine.

Read entire article at Renal Business Today

Kidney Patients Ask for More Information on Options

Many kidney failure patients want more detailed information about their treatment choices, according to a new study.

More than 30 percent of the 1,000 U.S. patients who took part in an Internet survey said they felt that the different therapies -- in-center hemodialysis, peritoneal dialysis, home hemodialysis and kidney transplantation -- were not "equally or fairly presented to them."

Nearly 70 percent of the respondents told the researchers that they were not provided with specific education and training about home hemodialysis, a relatively new option that may offer some advantages -- including ease of treatment -- over in-center dialysis.

Overall, the participants were moderately to highly satisfied with their current treatment, but satisfaction was highest among transplant patients and home dialysis patients, and lowest among in-center dialysis patients.

Doctors had the most influence over people's choice of therapies, the survey found. And, what patients said they wanted most was more information on new treatment and improved medications.

The study was published online Feb. 17 in the Clinical Journal of the American Society of Nephrology.

"Dialysis patients should be provided with enough information to choose optimal therapies," Dr. Stephen Fadem, of Baylor College of Medicine in Houston, and lead author of the report, said in a news release from the American Society of Nephrology.  "Our survey shows that dialysis patients do not always receive uniform, thorough information about all possible treatment methods and, as a result, are only moderately satisfied with their pre-treatment education."

~BusinessWeek.com~

Patients need wake-up call about link between kidney disease, diabetes

A multicultural study that will appear in the March issue of the Journal of Renal Care underscored the relationship between kidney disease and diabetes, and the need for greater awareness of this link.

In this small study, 23 South Asian diabetes patients and 25 white diabetes patients between the ages of 34 years and 79 years — with an average age of just older than 70 years — were surveyed to note any differences in the experiences, knowledge and attitudes of the two groups.

The researchers, led by Gurch Randhawa, director of the Institute for Health Research at the University of Bedfordshire, and research fellow Emma Wilkinson, found that many of the patients studied were unaware of possible kidney problems before their referral to specialist services. Overall, patients felt that they had received limited information about possible complications when they were diagnosed with diabetes, the researchers noted.

"Our research shows that low awareness and lack of information about kidney problems are common in both the South Asian and white patients we spoke to," Randhawa said. "In some cases, this was exacerbated by language barriers. The findings also demonstrate that the long-term educational needs of patients who have had diabetes for many years are just as important as the need to make newly diagnosed patients aware of all the health risks they face."
~ Drug Store News ~

Foot Problems Common Among Dialysis Patients

What is the problem and what is known about it so far?
Foot problems are common among people with diabetes. Most often, they occur because of nerve damage or poor blood circulation in the feet and legs. People with diabetes can develop serious ulcers (open sores) on their feet that are likely to get infected and are difficult to heal. As a result, people with diabetes are more likely than others to eventually need foot or leg amputations. Studies have shown that diabetic foot problems are more common among some ethnic groups than others. Studies have also found links between foot problems and other complications of diabetes, such as kidney disease. More study is needed to fully understand such links and how they may help to identify those in need of help to avoid foot problems and amputations.

Why did the researchers do this particular study?
The researchers wanted to learn more about how frequent foot problems are among people from different ethnic groups who have diabetes and advanced kidney disease.

Who was studied?
The study included 466 patients with diabetes from different ethnic backgrounds in the United States and the United Kingdom. The patients were receiving dialysis therapy for kidney failure.

Read entire article here

CMS issues final rule for dialysis facility quality incentive program

The Centers for Medicare & Medicaid Services issued a final rule for the Quality Incentive Program that will establish performance standards for dialysis facilities and provide payment adjustments to individual End-Stage Renal Disease facilities based on how well they meet these standards.

The final rule establishes the ESRD QIP performance standards, sets out the scoring methodology CMS will use to rate providers quality of dialysis care, and establishes a sliding scale for payment adjustments based on the facilities performance.  CMS will assess each dialysis facility on how well its performance meets the standard for each measure and will calculate each facilities Total Performance Score. The maximum Total Performance Score a facility can achieve is 30 (10 points per measure).  Facilities that do not meet or exceed performance standards will be subject to a payment reduction of up to 2% depending on how far their performance deviates from the standards.

CMS finalized three measures as the initial measure set during the first program year.  Two of these measures are designed to assess whether patients hemoglobin levels are maintained in an acceptable range, while the third measures the effectiveness of the dialysis treatment in removing waste products from patients blood.   
 
In future years CMS may add quality measures and establish additional performance standards that facilities will need to meet to receive full payment for the services they furnish to Medicare beneficiaries.

Read entire article here

Dialysis Data, Once Confidential, Shines Light on Clinic Disparities

For years, the government has collected a rich store of data about the performance of individual dialysis facilities. But it has kept nearly all the information secret from those it might benefit most: Patients.

Now ProPublica has obtained this data under the Freedom of Information Act. We are making a comprehensive set of clinic records publicly available  for the first time on our website.

Patients and others can search for a clinic and see how it compares on 15 key measures, ranging from mortality and hospitalization to transplant rates and infection control. Also on the site are historical reports dating to 2002.

Release of the data is long overdue, patient advocates say.

"It gives you a snapshot of what a clinic is about," said Roberta Wager, a past president of the American Association of Kidney Patients who works as a nurse and patient educator at several dialysis clinics in Texas. "This is your life. Wouldn't you want to have everything in your favor?"

There are almost 400,000 Americans who depend on chronic dialysis to do what their failed kidneys cannot, a number that has grown swiftly over the past two decades, spurred by epidemics of obesity and diabetes.


More than 5,000 facilities have sprung up to provide them with care, stretching into the nation's most rural areas and competing for patients in urban and suburban areas.

Patients today have more choice than ever. Yet most pick centers based on convenience, or on what their doctors suggest, with little notion that even clinics within the same communities can have substantial disparities.


In more than 200 counties nationwide, the data show, the gap between facilities with the best and worst patient survival, adjusted for case-mix differences, is greater than 50 percent. In areas such as Allegheny County, Pa., or Franklin County, Ohio, each with upwards of two dozen clinics, the differences are even more substantial, exceeding 200 percent.

There is also wide variability in how often patients at different clinics are hospitalized for septicemia. Although septicemia cases can be unrelated to dialysis, it is a significant risk for patients, who typically have their blood cleaned of toxins three times a week. Nationally, the rate was about 12 percent a year for 2006 to 2008. But in dozens of counties, the spread between facilities with the highest and lowest rates was more than 25 percentage points.

Read entire article here

New York City to Start Organ Ambulances

Renal Business Todays editor Keith Chartier





New York City will start sending out a second ambulance to scenes in which someone may be in danger of dying in order to quickly harvest organs that can be used for transplant.

The federally funded five-month trial will be limited to Manhattan between 4 pm and midnight to adults between 18 and 60 years old, and to people who die of cardiac arrest outside of a hospital.

The development of the program was fraught with ethical concerns, but those behind it felt that organs needed to be obtained sooner outside the hospital before the organ becomes unusable.

To read entire article on Renal Bizblog, click here

Making Sugar Count During The Holidays

American Diabetes Association - If you like sweets, one of the most tempting parts of the holidays is the dessert. Even though you have diabetes, you can still fit sweets into your meal plan.

Eating high-sugar foods like cakes, candy, cookies, and pies will make blood glucose rise, so do not just add them to your diet. Instead, substitute small portions of these sweets for other carbohydrates already in your meal plan. For example, if you want a small serving of pumpkin pie, then pass on eating a dinner roll during the main course.

 To view Desserts During the Holidays, click here

Cost of diabetes could be $3.35 trillion by 2020

The number of Americans diagnosed with diabetes and the related costs of the disease could reach catastrophic proportions, according to new research by the UnitedHealth Group.

The new projections are alarming, as more than 50% of Americans could have prediabetes or diabetes by 2020, which could carry a healthcare price tag of $3.35 trillion over the decade. New estimates show diabetes and prediabetes will account for an estimated 10% of total healthcare spending by the end of the decade at an annual cost of almost $500 billion –– up from an estimated $194 billion this year, UnitedHealth said in its new report, “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead.”

Estimates in the report were calculated using the same model as the widely cited 2007 study on the national cost burden of diabetes commissioned by the American Diabetes Association, UnitedHealth noted.

Read more here

Survey: Most consumers turn to blogs, Facebook for health info

A social media go-to-market strategy is fast becoming a must-have for companies these days, especially those companies operating in the healthcare arena. It’s no longer enough to push patient education out through a branded online page anymore, not with the growing prominence of social media sites. Today, companies need to seed that education across Facebook and Twitter and/or actively engage bloggers and heavy users to successfully get that education out to the masses online.

An Accenture survey released Tuesday found that U.S. consumers seeking medical advice are turning to medical websites, social media sites, online communities and informational websites in far greater numbers than the websites of pharmaceutical companies. According to the survey, of the more than two-thirds (68%) of consumers who go online for health information, slightly more than 1-in-10 regularly turn to a pharmaceutical company’s website to seek information about an illness or medical condition, compared with 92% who more frequently look to other online resources.

That patient traffic helps illustrate the fundamental shift from a predominantly one-way company-to-patient dialogue to enabling a patient-to-patient — and even a patient-to-healthcare-professional dialogue — through the evolution of social networks and online communities.

“Pharmaceutical companies that embrace innovations, such as social networking and communications via mobile devices, and integrate and align their communication strategy across multiple channels will be positioned to have a much greater influence on their patients’ choices and, consequently, realize significant increases in revenue, profitability and sustained competitive advantage,” stated Tom Schwenger, global managing director for Accenture’s Life Sciences Sales and Marketing practice.

Read more here

Dialysis: An Experiment In Universal Health Care

Every year, more than 100,000 Americans start dialysis treatment, a form of chronic care given to people with failing kidneys. And for many, the cost is completely free. Since 1972, when Congress granted comprehensive coverage under Medicare to any patient diagnosed with kidney failure, both dialysis and kidney transplants have been covered for all renal patients.

But a new joint investigation between The Atlantic and ProPublica found many problems with dialysis in the U.S.: The cost of treatment is among the world's highest, while the U.S. mortality rate for dialysis patients is one of the world's worst. One in four patients will die within 12 months of starting treatment.

Investigative reporter Robin Fields, who spent the past year reviewing thousands of documents and interviewing more than 100 patients, doctors, policymakers and experts, found systematic failures in the way dialysis centers are set up in the United States.

"At clinics from coast to coast, patients commonly receive treatment in settings that are unsanitary and prone to perilous lapses in care," she writes in a piece that will be published in the December issue of The Atlantic. "Regulators have few tools and little will to enforce quality standards. Industry consolidation has left patients with fewer choices of provider. [And] the government withholds critical data about clinics' performance from patients, the very people who need it most."

Read more on A Growing Industry

Advocating for Patients with Diabetic Nephropathy

Although no cure exists, pharmacologic and nonpharmacologic measures can help patients prevent onset or progression of diabetic nephropathy to preserve kidney function.

Diabetes is the seventh-leading cause of death in the United States and the primary cause of end-stage renal disease. Diabetic nephropathy is a longterm consequence of diabetes, estimated to affect 20% to 40% of patients with diabetes. Although there is no cure for diabetic nephropathy, by understanding the pathophysiology, preventative strategies, and interventions to slow the progression of this disease, the pharmacist can be better prepared to advocate for kidney function preservation.

Pathophysiology
Although the exact cause of diabetic nephropathy is unknown, several mechanisms have been hypothesized. Hyperglycemia, the formation of advanced glycosylation products, activation of the renin-angiotensin- aldosterone system, and activation of cytokines are all thought to be contributing factors to the progression of disease.

Hyperglycemia appears to cause expansion and injury of the glomerular basement membrane of the kidneys by increasing the renal mesangial cell glucose concentration. Initially, the glomerular mesangium expands by cell proliferation and later by cell hypertrophy. Transforming growth factor beta (TGF-beta) is particularly important in causing the expansion and later fibrosis by stimulating the production of both collagen and fibronectin. Other cytokines that are present in the kidney are also under investigation for their role in diabetic nephropathy.

Advanced glycosylation products are formed as glucose binds reversibly—and eventually irreversibly—to proteins in the kidneys. The glycosylation products can eventually form complex cross-links over time as the hyperglycemia continues and can contribute to renal damage by stimulation of growth and fibrotic factors.

In diabetic nephropathy, the local renin-angiotensin system is activated. Angiotensin II is stimulated and results in constriction of the efferent arteriole of the glomerulus, which results in increased glomerular capillary pressures. Angiotensin II also stimulates renal mesangium expansion and fibrosis through activation of angiotensin II type 1 receptors, and increases the expression of TGF-beta and other growth factors.

Microalbuminuria (30-300 mg/L) may contribute to renal injury associated with diabetic nephropathy. An increase in glomerular permeability causes plasma proteins such as albumin to be secreted into the urine. A portion of these proteins is absorbed by the proximal tubular cells, which can trigger an inflammatory response that contributes to kidney damage. Macroalbuminuria (>300 mg/L), nephrotic syndrome, and eventually renal failure may occur during the later stages of diabetic nephropathy.

Read entire article at Pharmacy Times

Most diabetics do not change oral health habits after diagnosis

Many active diabetes managers have not changed their oral care habits since being diagnosed, despite the fact they are at higher risk for developing serious complications from poor oral hygiene, according to a study by dLife, a multimedia network serving the diabetes community, and market research firm SoundView Research.

Furthermore, more than half of active diabetes managers surveyed had not been advised by their dentists to take extra care to brush, floss or rinse daily.

"The results of this study show the gulf that exists between perceptions and the connections between diabetes and oral health. Your dental health absolutely affects the control of your diabetes," stated Charles Martin, a dentist, author and founder of DentistryForDiabetics.com. "Inflammation in the mouth coming from gum disease spreads to the whole body. This inflammation increases insulin resistance, cholesterol levels and C-reactive protein levels. So, uncontrolled oral disease can be the hidden factor working against those trying to maintain good control over their diabetes."

Click here to read entire article

Kidney Transplant Numbers Increase for Elderly Patients

Elderly patients with kidney failure get kidney transplants more often than they did a decade ago, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The results suggest that the chances of receiving a kidney transplant are better than ever for an older patient who needs one.

Kidney failure afflicts nearly half a million individuals in the United States, and 48% of sufferers are 60 years of age or older. Kidney disease patients who obtain a transplant live longer than those that remain on dialysis. Fortunately, living and deceased organ donations are on the rise; however, transplant waiting lists have become increasingly long as more and more people develop kidney dysfunction.

Elke Schaeffner, MD (Charité University Medicine, in Berlin, Germany), along with Caren Rose and John Gill, MD (St. Paul's Hospital, University of British Columbia, in Vancouver, Canada) examined whether elderly patients with kidney failure have better or worse access to transplants now than they did in the past. The study included patients with kidney failure in the United States aged 60 to 75 years listed in the United States Renal Data System between 1995 and 2006.

The study revealed that elderly patients rarely receive a transplant, but they were twice as likely to get one in 2006 as in 1995. (In 2006, they had a 7.3% likelihood of getting a transplant within three years of their first treatment for kidney failure.) Elderly patients now benefit from greater access to organs from living donors and older deceased donors compared to a decade ago. They also die less frequently while waiting for a kidney than they did in the past.

To read entire article click here

Diabetes prevalence among Americans may increase to 33%

The rate of diabetes among Americans is on an upswing and likely will reach epic proportions by 2050, costing the government millions.

A new study by the Centers for Disease Control and Prevention and published in Population Health Metrics found that annual diagnosed diabetes incidence (new cases) will increase from about eight cases per 1,000 people in 2008 to about 15 in 2050. The authors also projected that — assuming low incidence and relatively high diabetes mortality — total diabetes prevalence (diagnosed and undiagnosed cases) is projected to increase from 14% in 2010 to 21% of the U.S. adult population by 2050, but noted that  if recent increases in diabetes incidence continue and diabetes mortality is relatively low, prevalence will increase to 33% by 2050.

Read entire article here

History of diabetes treatment chronicled in New York Historical Society exhibition

Recalling the desperate fight for life that once was waged by juvenile diabetes patients and commemorating the events of the 1921 discovery by Toronto physician Frederick Banting that inaugurated a new era of hope for them and their families, the New York Historical Society will present the exhibition "Breakthrough: The Dramatic Story of the Discovery of Insulin" from October 5, 2010 through January 31, 2011.

Highlighting the roles of science, government, higher education, and industry in the development and distribution of a life-saving drug, the exhibition will bring to life the personalities who discovered insulin and raced to bring it to the world, and will tell the story of one extraordinary girl — Elizabeth Evans Hughes, daughter of statesman and Supreme Court Justice Charles Evans Hughes — who was among the very first patients to be saved.

"This is a powerful story that deals with type 1 diabetes and the discovery of insulin in that very early period. You can imagine the number of desperate people all over the world who wanted [an effective treatment]," said Stephen Edidin, chief curator of the Society's Museum Division. 

Read entire article here

Gestational diabetes test may predict Type 2 diabetes among women

A new Tel Aviv University study found a test used to diagnose gestational diabetes in women could be a key indicator to diagnosing Type 2 diabetes.

The study -- led by Gabriel Chodick of Tel Aviv University's department of epidemiology and preventive medicine at the Sackler faculty of medicine -- found that women who "failed" the glucose challenge test, a series of four blood tests conducted over a single four-hour period, have a higher chance of developing adult onset diabetes later in life. Chodick and colleagues collected data on more than 185,000 women in Israel who took the glucose challenge test, then acquired information from the nation's health registry as to what percentage of these women contracted diabetes later in life.

Read more here

Diabetes and Kidney Disease

Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body.

Are there different types of diabetes?

The most common ones are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life.

Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult onset diabetes mellitus. It is also called non insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans and Asian Americans.

Read entire article here